rifampin and Arthritis

Leprosy, a chronic granulomatous infection caused by Mycobacterium leprae, classically presents with cutaneous and neurological manifestations. Musculoskeletal involvement though third most common is underdiagnosed and underreported. It may manifest in the form of Charcot's arthropathy, acute symmetrical polyarthritis or swollen hands and feet syndrome during lepra reactions, insidious-onset chronic symmetrical polyarthritis mimicking RA or as isolated tenosynovitis or tenosynovitis associated with arthritis or neuropathy. At times, articular involvement may be the sole presenting manifestation even without cutaneous lesions. Other rheumatological manifestations occasionally reported are enthesitis, sacroiliitis, cryoglobulinaemic vasculitis and DM. With increasing travel of population between tropical and temperate zones, it is likely that rheumatology clinics in countries free of leprosy may come across cases of leprosy with rheumatological manifestations. Delay in diagnosis and management may be detrimental and may result in deformities and loss of function. Not only this, but recent reports of leprosy being diagnosed in native white populations following anti-TNF-α therapy should alert rheumatologists across the globe to be more familiar with this disease. This review is aimed at presenting a comprehensive clinical scenario of various rheumatological manifestations of leprosy to sensitize rheumatologists and physicians across the continents.

Topics: Arthritis; Clofazimine; Dapsone; Diagnosis, Differential; Humans; Leprostatic Agents; Leprosy; Mycobacterium leprae; Rifampin

Both osteoarticular tuberculosis (OA-TB) and inflammatory arthritis can lead to osteoarticular structural damage. These conditions exhibit similar symptoms, physical signs, and imaging features. Rapidly and accurately diagnosing OA-TB in patients with inflammatory arthritis presents a challenge to clinicians. Xpert MTB/RIF (Xpert) has been endorsed by the World Health Organization (WHO) as a rapid diagnostic tool for diagnosis of pulmonary and extrapulmonary TB. This study was designed to investigate diagnostic efficiency of Xpert for OA-TB in patients with inflammatory arthritis in China.. A total of 83 consecutive patients with inflammatory arthritis and suspected OA-TB were enrolled prospectively from June 2014 to May 2018. Demographic, clinical, and biological data were recorded. Xpert assay, smear microscopy examination (smear), BACTEC MGIT 960 (MGIT 960), pathological examination, and T-SPOT.TB test were performed for each patient who received operations. Diagnostic efficiency of Xpert was evaluated based on a composite reference standard (CRS).. A total of 49 out of 83 patients with inflammatory arthritis and suspected OA-TB received operations, and 49 specimens were obtained during operations. According to CRS, 36 out of 49 patients with inflammatory arthritis were diagnosed with OA-TB, and 13 were not affected by the condition. Sensitivity of Xpert assay, smear, MGIT 960, pathological examination, and T-SPOT.TB test reached 66.70% (24/36), 25.00% (9/36), 30.55% (11/36), 47.22% (17/36), and 80.55% (29/36), respectively. Specificity of Xpert assay, smear, MGIT 960, and pathological examination was all 100% (13/13). Specificity of T-SPOT.TB test was 53.84% (7/13). Sensitivity of Xpert was higher than that of smear, MGIT 960 and pathological examination, but the sensitivity of Xpert was lower than that of T-SPOT.TB. Sensitivity of Xpert was statistically different from that of smear and MGIT 960 (P<0.001, P = 0.002), but the sensitivity of Xpert was not significantly different from that of pathological examination and T-SPOT.TB (P = 0.096, P = 0.181). Specificity of T-SPOT.TB was less than that of Xpert, smear, MGIT 960, and pathological examination, and the difference between them was statistically significant (P = 0.015). Among the 27 OA-TB patients with smear negative results, Xpert had the highest sensitivity, but sensitivity of Xpert was not significantly different from that of pathological examination and T-SPOT.TB (P = 0.413, P = 0.783). 2 of 36 OA-TB patients exhibited RIF resistance. Xpert was concordant with MGIT 960-based drug susceptibility testing (DST) in detecting rifampin (RIF) resistance.. Xpert is an efficient tool with high sensitivity and specificity for OA-TB diagnosis in patients with inflammatory arthritis in high-TB prevalence countries. Compared with conventional methods, Xpert has two advantages: one is fast, and the other is able to provide RIF resistance information simultaneously.

Topics: Adult; Aged; Antibiotics, Antitubercular; Arthritis; China; DNA, Bacterial; Dried Blood Spot Testing; Drug Resistance, Bacterial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium tuberculosis; Prospective Studies; Real-Time Polymerase Chain Reaction; Rifampin; Sensitivity and Specificity; Tuberculosis, Osteoarticular

Topics: Aged; Amino Acid Sequence; Amino Acid Substitution; Anti-Bacterial Agents; Arthritis; DNA-Directed RNA Polymerases; DNA, Bacterial; Drug Resistance, Bacterial; Humans; Listeria monocytogenes; Listeriosis; Mutation, Missense; Point Mutation; Polymerase Chain Reaction; Prosthesis-Related Infections; Rifampin; Sequence Analysis, DNA

Outcome of patients with streptococcal prosthetic joint infections (PJIs) is not well known.. We performed a retrospective multicenter cohort study that involved patients with total hip/knee prosthetic joint (THP/TKP) infections due to Streptococcus spp. from 2001 through 2009.. Ninety-five streptococcal PJI episodes (50 THP and 45 TKP) in 87 patients of mean age 69.1 ± 13.7 years met the inclusion criteria. In all, 55 out of 95 cases (57.9 %) were treated with debridement and retention of the infected implants with antibiotic therapy (DAIR). Rifampicin-combinations, including with levofloxacin, were used in 52 (54.7 %) and 28 (29.5 %) cases, respectively. After a mean follow-up period of 895 days (IQR: 395-1649), the remission rate was 70.5 % (67/95). Patients with PJIs due to S. agalactiae failed in the same proportion as in the other patients (10/37 (27.1 %) versus 19/58 (32.7 %); p = .55). In the univariate analysis, antibiotic monotherapy, DAIR, antibiotic treatments other than rifampicin-combinations, and TKP were all associated with a worse outcome. The only independent variable significantly associated with the patients' outcomes was the location of the prosthesis (i.e., hip versus knee) (OR = 0.19; 95 % CI 0.04-0.93; p value 0.04).. The prognosis of streptococcal PJIs may not be as good as previously reported, especially for patients with an infected total knee arthroplasty. Rifampicin combinations, especially with levofloxacin, appear to be suitable antibiotic regimens for these patients.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthritis; Arthroplasty, Replacement, Knee; Drug Therapy, Combination; Female; Hip Prosthesis; Humans; Knee Joint; Knee Prosthesis; Levofloxacin; Male; Middle Aged; Prosthesis-Related Infections; Retrospective Studies; Rifampin; Streptococcal Infections; Treatment Outcome

Data on the tolerance and effectiveness of rifampicin-levofloxacin combination therapy (RLCT) in patients treated for prosthetic joint infections (PJIs) according to daily dosage are lacking. A review of the clinical data from patients treated with RLCT for PJIs in a French referent center for PJIs was conducted. A total of 154 patients (75 F/79 M), with a median age of 64.1 years and median body weight of 83.1 kg, were included. The median daily dosages of rifampicin and levofloxacin were, respectively, 1,200 mg (range 300-2,100) and 750 mg (range 500-1,500), corresponding to a mean daily dose per kg of, respectively, 16.2 ± 4.3 mg/kg and 10.1 ± 3.0 mg/kg. After a mean follow-up period of 55.6 ± 27.1 months (range 24-236), 127 patients (82.5 %) were in remission. Adverse events attributable to rifampicin and levofloxacin were reported in 48 (31.2 %) and 13 (8.4 %) patients (p < 0.001), respectively. Patients who experienced rifampicin-related adverse events had been given higher rifampicin daily doses than the other patients (p = 0.04). The rifampicin daily dosage did not influence patient outcome and nor did the levofloxacin daily dosage on both tolerance and patient outcome. Our results suggest that adjusting rifampicin daily doses to the patient total body weight when combined with levofloxacin for the treatment of PJIs is associated with a poor tolerance. High daily doses of rifampicin (>600 mg) and levofloxacin (750 mg) do not improve patient outcome when compared to lower daily doses in this setting.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthritis; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Female; Follow-Up Studies; France; Humans; Levofloxacin; Male; Middle Aged; Prevalence; Prosthesis-Related Infections; Rifampin; Treatment Outcome; Young Adult

Brucellosis is considered a known widespread zoonotic disease and is endemic in Mediterranean region, like Iran. This study reviewed the clinical manifestations, laboratory findings, and therapeutic regimen in childhood brucellosis in Iran. In this retrospective study, we reviewed hospital-records of 34 consecutive children with a confirmed diagnosis of brucellosis among a total number of 10,864 patients admitted to Children's Medical Center, Tehran, Iran, between 2002 and 2010. Among the patients diagnosed with brucellosis, 22 (65%) were admitted during spring and summer. Clinical findings of these patients at admission were arthritis, splenomegaly, hepatomegaly, lymphadenopathy, maculopapular skin rashes, and fever. Anaemia (53%) and leukopenia (33%) were the most common findings in the children. Only one patient had presented with leukocytosis. Four children (12%) were thrombocytopenic, and none of patients had pancytopenia. Blood cultures were positive in 5 patients (23%). Only one patient underwent bone-marrow aspiration and had positive culture for Brucella spp. Positive titres were found in 33 cases (97%) in Wright test, 23 cases (96%) in Coombs test, and 16 patients (72.7%) in 2ME (2-Mercaptoethanol) test. In one case, Wright and Coombs test titres were below 1:80 while Brucella spp. were isolated from blood at the same time. It is concluded, prolonged fever with joint involvement and organomegaly may increase possibility of infection with Brucella spp. Appropriate treatment regimen by more tolerable oral drugs, with a duration of at least 8 weeks, is recommended.

Topics: Adolescent; Anti-Infective Agents; Arthritis; Brucellosis; Child; Child, Hospitalized; Child, Preschool; Doxycycline; Drug Therapy, Combination; Exanthema; Female; Fever; Hepatomegaly; Humans; Iran; Laboratories; Lymphatic Diseases; Male; Referral and Consultation; Retrospective Studies; Rifampin; Splenomegaly; Sulfamethoxazole; Trimethoprim

Topics: Anti-Inflammatory Agents; Arthritis; Arthritis, Rheumatoid; Clofazimine; Dapsone; Delayed Diagnosis; Diagnosis, Differential; Humans; Leprostatic Agents; Leprosy; Male; Middle Aged; Prednisolone; Rifampin; Treatment Outcome

We describe a septic loosening of a hip prosthesis in a 71-year-old woman caused by Gardnerella vaginalis. Infection was confirmed by culture and molecular identification of this bacterium. The patient was treated by a one-step exchange of prosthesis and antibiotic therapy combining trimethoprim-sulfamethoxazole and rifampin, with favorable evolution.

Topics: Aged; Anti-Bacterial Agents; Arthritis; Arthroplasty, Replacement, Hip; Bacterial Infections; Female; Gardnerella vaginalis; Humans; Molecular Sequence Data; Prosthesis-Related Infections; Rifampin; Sequence Analysis, DNA; Trimethoprim, Sulfamethoxazole Drug Combination

Several forms of arthritis and rheumatism can sometimes complicate leprosy. However, its presentation as an acute onset arthritis is unusual. We report two adult male naïve patients who presented to our rheumatology outpatient clinic with acute onset inflammatory polyarthritis, skin rash and mild sensory neurodeficit. Borderline lepromatous leprosy (in type I lepra reaction) was diagnosed. We also refer to 19 case records of Hansen arthritis in the clinic database (1998-2007) from approximately 35,000 patients and a community study to highlight the missed diagnosis of Hansen's disease and its unusual association with rheumatoid arthritis. In countries like India where leprosy is endemic, this disease also merits attention in rheumatology clinics.

Topics: Acute Disease; Aged; Arthritis; Clofazimine; Dapsone; Diagnosis, Differential; Drug Therapy, Combination; Exanthema; Glucocorticoids; Humans; Leprostatic Agents; Leprosy; Male; Middle Aged; Mycobacterium leprae; Peripheral Nerves; Peripheral Nervous System Diseases; Rifampin; Treatment Outcome

Leprosy is generally revealed by cutaneous lesions often associated to nerve impairment. Rarely, it may be revealed by polyarthritis. The diagnosis, often delayed in the cutaneous-nevritic form because of the low prevalence of the disease in metropolitan France, is very difficult in case of rheumatic presentation. We report the case of a 28 year-old woman from Mali, who was diagnosed with lepromatous borderline leprosy with reversal reaction occurring in the postpartum as she presented with polyarthritis and skin lesions.

Topics: Administration, Oral; Adrenal Cortex Hormones; Adult; Arthritis; Biopsy; Clofazimine; Dapsone; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Rifampin; Skin; Treatment Outcome

Topics: Aged, 80 and over; Antitubercular Agents; Arthritis; Aza Compounds; Drug Therapy, Combination; Fluoroquinolones; Humans; Isoniazid; Male; Moxifloxacin; Pyrazinamide; Quinolines; Rifampin; Tuberculosis, Pulmonary

Musculoskeletal symptoms are not infrequent in leprosy and, when inaugural, may be difficult to differentiate from other conditions, most notably rheumatoid arthritis. We report the case of a 24 year-old man with a 5 year history of intermittent inflammatory arthritis and fever. Physical findings and radiographs were normal initially. Several years later, he had severe wasting of the hand muscles, stocking-glove sensory loss, burn scars on the hands, and plantar ulcers. Electrophysiological test results indicated sensory-motor neuropathy with predominant demyelination. Laboratory tests showed inflammation without immunological abnormalities. A prominent endoneurial inflammatory infiltrate composed of mononuclear cells was seen on a nerve biopsy specimen, suggesting leprosy. A family study then revealed that the patient's aunt had been diagnosed with leprosy. Dapsone, clofazimine, and rifampin were given. The joint manifestations and laboratory tests for inflammation improved. However, no changes were noted in the neurological symptoms.

Topics: Adult; Arthritis; Chronic Disease; Clofazimine; Dapsone; Diagnosis, Differential; Drug Therapy, Combination; Electrophysiology; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Musculoskeletal System; Neurons; Radiography; Rifampin; Toes

A major concern surrounding the use of tumor necrosis factor-alpha (TNF-alpha) inhibitors is their potential to increase the risk of opportunistic infections, particularly tuberculosis (TB).. To estimate the incidence of active TB in patients with rheumatic diseases receiving anti-TNF drug therapy and to evaluate the effectiveness of an antituberculosis chemoprophylaxis regimen.. Retrospective study of the files of 613 patients with rheumatic diseases who had received anti-TNF agent (etanercept, infliximab and adalimumab) therapy from July 2000 to June 2004 at the Aristotle University of Thessaloniki, Greece. All patients had a tuberculin skin test (TST) and a postero-anterior chest radiograph (CXR) prior to anti-TNF therapy. When indicated (TST > or =10 mm and/or fibrotic lesions on CXR), treatment for latent TB was established (6 months isoniazid [INH] or 3 months INH and rifampicin [RMP]). Anti-TNF agent therapy was started again 2 months later.. Of 45 patients who fulfilled the criteria for chemoprophylaxis, only 36 were treated correctly. Eleven patients developed active TB 2-35 months after the beginning of anti-TNF therapy. Six patients developed pulmonary and five extra-pulmonary TB. Eight of these had received infliximab and three adalimumab.. The incidence of active TB in this study population was estimated at 449 cases per 100,00 population annually. Anti-tuberculosis chemoprophylaxis was only of partial preventive success in these patients.

Topics: Adalimumab; Adult; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Antitubercular Agents; Arthritis; Arthritis, Rheumatoid; Comorbidity; Etanercept; Female; Greece; Humans; Immunoglobulin G; Incidence; Infliximab; Isoniazid; Male; Middle Aged; Receptors, Tumor Necrosis Factor; Retrospective Studies; Rifampin; Spondylitis, Ankylosing; Tuberculosis; Tuberculosis, Pulmonary

Topics: Anti-Bacterial Agents; Arthralgia; Arthritis; Arthritis, Infectious; Arthroplasty, Replacement, Knee; Atorvastatin; Combined Modality Therapy; Debridement; Diagnosis, Differential; Doxycycline; Drug Interactions; Female; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hyperlipoproteinemia Type II; Levofloxacin; Middle Aged; Ofloxacin; Postoperative Complications; Prosthesis-Related Infections; Pyrroles; Recurrence; Reoperation; Rifampin; Thyroiditis, Autoimmune; Thyroxine; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Arthritis; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Middle Aged; Rifampin; Temporomandibular Joint; Temporomandibular Joint Disorders

We report on three Italian children who presented with unilateral ankle tuberculosis (TB) consecutively during a short time period and in the same geographical area. A 6-year-old-girl with a family history of TB had limited mobility of the right leg at age 9 months; Mantoux test and radiographs at that age yielded normal findings. When severe right tibiotarsal swelling, reddening, pain and restriction of motion became apparent at age 4.6 years, the typical lesions of TB were evident on radiographs and computed tomographic (CT) scans. Mantoux test and synovial biopsy confirmed TB. A three-drug regimen of treatment proved useless: articular cartilage destruction and diffuse osteosclerosis ensued. Only a four-drug prolonged regimen of treatment proved to be somewhat effective. A 5-year-old girl had a 6-month history of painless swelling and limited mobility of the ankle; radiographs and CT showed osteopenia with marginal erosion of cartilages. A 14-month-old boy presented with a 2-week history of painless swelling ankle. Radiographs showed decreased bone density of talocalcanear bones. Mantoux test and synovial biopsy confirmed TB in both patients; treatment with a three-drug regimen greatly reduced symptoms. A careful suspicion of the diagnosis of tuberculosis is paramount in children with chronic or subacute monoarticular arthritis, even in absence of a positive tuberculin test or abnormalities on chest radiograph. When negative early on, the tuberculin test should be repeated after 6 weeks of arthritis, and a needle biopsy of the synovium is required in those children with monoarticular arthritis and a positive tuberculin test. Careful therapy is necessary to avoid sequelae that may lead to severe osteoarticular damage.

Topics: Ankle Joint; Arthritis; Biopsy; Child; Drug Therapy, Combination; Female; Humans; Infant; Isoniazid; Male; Osteomyelitis; Pyrazinamide; Radiography; Rifampin; Tomography, Emission-Computed; Tuberculosis, Osteoarticular

Topics: Adolescent; Adult; Arthritis; Drug Therapy, Combination; Ethambutol; Female; Gout; Humans; Male; Middle Aged; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary; Uric Acid

Three studies of drug toxicity were made in Chinese adults with pulmonary tuberculosis admitted concurrently to short-course antituberculosis regimens. The first was of streptomycin plus isoniazid plus pyrazinamide given daily (SHZ regimen), three times a week (S3H3Z3 regimen) or twice a week (S2H2Z2 regimen). The second was of pyrazinamide in the SHZ regimen and PAS in the standard daily combination of streptomycin plus isoniazid plus PAS (SPH regimen). The third was of the SHZ regimen and these 3 drugs plus rifampicin daily (SHRZ regimen). In study 1 (174 SHZ, 185 S3H3Z3, 182 S2H2Z2 patients), the incidence of arthralgia was associated with the number of doses per week (P less than 0.001). The incidence of other reactions, most of which were cutaneous or vestibular, or symptomless increases in the serum alanine transaminase (AIT) concentration, was similar on all 3 regimens. In study 2 (142 SHZ, 137 SPH patients), hepatic reactions occurred on the SHZ but not on the SPH regimen (P less than 0.002), serum AIT concentrations were distributed over a higher range on the SHZ regimen, and 2 patients had jaundice. Gastrointestinal reactions were more frequent on the SPH regimen (P = 0.06). Arthralgia was commoner on the SHZ regimen (P less than 0.05). In study 3 (38 SHZ, 41 SHRZ patients), the incidence of hepatic reactions, jaundice and arthralgia was similar in the 2 regimens. On the pyrazinamide regimens combined, hepatic reactions were marginally more frequent in patients with Australia antigen or antibody either before or during chemotherapy (P = 0.09). Serum uric acid concentrations were higher in patients on daily than on intermittent pyrazinamide (P less than 0.005), and in patients with arthralgia on the daily pyrazinamide regimen than in matched controls (P = 0.07).

Topics: Aminosalicylic Acids; Arthritis; Chemical and Drug Induced Liver Injury; Drug Eruptions; Drug Therapy, Combination; Gastrointestinal Diseases; Hong Kong; Humans; Isoniazid; Labyrinth Diseases; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis, Pulmonary

Topics: Aminosalicylic Acids; Antitubercular Agents; Arthritis; Chemical and Drug Induced Liver Injury; Child; Cycloserine; Drug Hypersensitivity; Drug Resistance, Microbial; Ethambutol; Ethionamide; Humans; Isoniazid; Kanamycin; Liver; Lupus Vulgaris; Male; Middle Aged; Pyrazinamide; Rifampin; Streptomycin; Tuberculin Test; Tuberculosis; Viomycin

Topics: Animals; Anti-Inflammatory Agents; Antibiotics, Antineoplastic; Arthritis; Aspirin; Azathioprine; Chloramphenicol; Cyclophosphamide; Dexamethasone; Drug Antagonism; Edema; Hydrocortisone; Immunosuppressive Agents; Indomethacin; Inflammation; Male; Mefenamic Acid; Mercaptopurine; Nystatin; Phenylacetates; Phenylbutazone; Prednisolone; Rats; Rifampin; Triamcinolone